Patrick Ward takes a light-hearted approach to emphasise an anaesthetist’s commitment to cleanliness
To: All anaesthetists, ODAs, ODPs, PAs, theatre and ICU staff with a commitment to cleanliness
When: Every time central venous, large-bore peripheral venous and arterial access is undertaken
Where: Anaesthetic room, operating theatre, emergency department and ICU
Dresscode: Theatre scrubs +/- gloves/gown/mask/hat
Drink: BYOB (of chlorhexidine)
RSVP: By letter to the editor, Journal of Anaesthesia Practice email@example.com
There are many traits that distinguish anaesthetists from surgeons, medics and emergency doctors, but none more apparent than our meticulous approach towards the art of vascular access – the distinct absence of a blood bath in the aftermath of central venous and arterial cannulation unmistakably separates us from the rest.
Much of this procedural finesse comes with practice and technique, but it can also be attributed to our fastidious nature and, in no small part, to teamwork. On the rare occasion that a drop of blood is spilled (the horror), we have at hand (or promptly have thrust into) an incopad or gauze swab to mop it up immediately, preventing soiling of patient gowns, bed linen, trolleys/theatre tables and floors. This commitment to cleanliness is essential in maintaining the good working relationship between anaesthetists and the other guests at an anaesthetic tea party.
Such is the importance of a correctly sized and placed incopad or gauze swab in preserving this blood-free harmonious state, that I propose a new vocabulary (that of the anaesthetic tea party) to describe the many permutations, ensuring a standardised approach:
The tea coaster
The tea coaster is a bundle of gauze swabs, to be placed within easy reach: a sterile bundle to be used for central venous cannulation; and a non-sterile bundle for large-bore peripheral venous/arterial access (Figures 1 and 4).
The table runner
The table runner is an incopad divided into thirds along its length to create a thin strip. To be placed under arm of patient and run along trolley or theatre table; used for large-bore peripheral venous/arterial access (Figure 1).
The tablecloth is an unfolded incopad placed under arm of patient and draped over armboard; used for large-bore peripheral venous/arterial access (Figure 2).
The place mat
The place mat is an incopad folded in half, placed under arm of patient and positioned on armboard; used for large-bore peripheral venous/arterial access (Figure 3).
The napkin is an unfolded incopad draped over knee of anaesthetist; used for arterial access only (Figure 4).
The doily is an incopad folded into quarters, positioned under patient head and neck; used for central venous cannulation only; chlorhexidine and drapes applied once doily in place (Figure 5).